Pelvic Floor Dysfunction - More common than you might think

HAVE A LOOK ATTHE NEW PELVIC FLOOR WORK - ITAFFECTS MORE PEOPLE THAN YOU MIGHT THINKPelvic Floor Dysfunction: What is it, why do you have it and how can you correct it?

To start with, new research in 2014 shows that 80% of women will have Pelvic Floor Dysfunction (PFD) at some point in their life and 30% will have stress incontinence. Men are also affected by PFD, frequently as a result of prostrate problems, although this is talked about much less.

What is Pelvic Floor Dysfunction?A dysfunctional muscle is one which will not contract nor release so it tends to be both tight and weak, and consequently, unable to function correctly.The pelvic floor is the muscle group which forms the 'under carriage' of your trunk. It supports your internal organs, includes the "bathroom" muscles and adds support to the sacro-iliac joint. So it is essential that it functions correctly. If it is dysfunctional it will be tight, short and weak instead of being flexible, long and strong.

The contributors to PFD include:PregnancyCrunches and sit upsPoor postureWearing high heelsSitting for too long

What is the solution?New research has identified that the pelvic floor will not work effectively in isolation, it will function up to 75% better through a specific mix of muscle group activation rather than with the traditional 'kegels' exercises (controlled lifting of the pelvic floor in isolation).In addition, all exercises should be performed with the pelvis in a neutral position, not in the pelvic tilt position.The specific mix of muscle group activation is to work the Glute (butt) muscles in conjunction with inner, and outer, thigh muscles. This is the key combination for optimum pelvic floor engagement and improved support to the pelvis.

The best exercises are:Squats with correct alignment to strengthen yet lengthen the pelvic floorShoulder bridge with a small ball between your kneesCurtsey or split squatsClam type exercise using fast and slow twitch pelvic floor activationCheck with an exercise professional to ensure that your technique is correct as this is essential to gain any PF benefit. The big benefit of this new approach is that by working this specific group of muscles, correctly, the pelvic floor will activate automatically.

Exercises to avoidAny exercise with a pelvic tilt as this shortens the pelvic floor muscle, encouraging dysfunction.Crunches or sit ups, which increase the downward pressure on the pelvic floor.High impact exercise.Pilates exercises such as 'the 100'

Would you like to know more?Just contact Anne by phone or email to discuss your needs. The correct exercises and techniques are taught in 'I Move Freely' Pilates Classes at The Studio

Why do you need strong 'glutes'?

When new people join a class or come to me with back pain they are usually completely unaware of their glute muscles. The glutes are quite likely to be weak and tight, which sounds like an odd combination.

Strengthening the muscle and stretching it so it can function correctly is an essential part of keeping your body working effectively and without pain.

Keeping correct alignmentStrong glutes can protect you from injury and reduce the impact of arthritic pain by providing support to the spine and pelvis. They also give correct alignment throughout the body helping to protect the knees from uneven wear, keep the feet lined up reducing problems with the achilles and plantar fascia.

Support when walking or running or weight trainingThe glute muscles stabilise your pelvis while you run or walk. They help with hip extension and forward propulsion. If they fail to engage correctly the work falls to the hip flexors which are less able and become tight quickly. This puts stress onto the lumbar spine giving back pain. Strong glutes help give correct positioning when weight training, especially during squats, so your knees are protected. They also help with protecting your back when bending to pick up items from the floor or gardening.

Injury preventionIf your glutes are not strong, your entire lower body alignment may become out of balance causing injuries such as achilles tendinitis, shin splints, knee pain and leading to tight ITB which runners are particularly susceptible to. When the glutes are not strong enough to do their job, other muscles not as well designed for the job take over. While in everyday life it is usually the back which suffers, in those who train at a higher level the muscle imbalance is more pronounced leading to increased risk of injury.

StrengthThe glutes are one of the largest muscle groups in the body. If trained it can produce an enormous amount of power. By strengthening this muscle you will be able to move with less stress on your skeletal structure. This is of enormous benefit as bones become less strong with age and affected by degenerative conditions.

Reduction in back painTo simplify the effect strong glutes have on back pain visualise your spine. It runs from the back of your head to your pelvis (hip bones). Your pelvis sits like a t junction at the bottom of your spine. Below this are your glutes, providing support to everything above it – hips and spine. Once you move they are powering from behind you enabling you to move easily with less effort. The other muscle groups, abdominals, quads and hip flexors are at the front of your body and while they are essential for movement and stability they are not nearly so well placed to provide power as the glutes.

How important is balance to your overall health and well being?

Many clients I see have very poor balance skills when they first attend The Studio. This usually improves hugely within a few weeks. I am frequently asked why it is that our balance is so bad, and, why it is important to improve it.

Firstly, why is our balance poor?Balance is a motor skill which we acquire in childhood. It requires the use of large muscles groups and although this skill remains with us throughout our lives it deteriorates with age. At any stage of your life it is possible to improve your balance skills with training.The ageing process causes muscle weakness which will affect the body's ability to recover from a trip on an uneven surface. With age often comes inner ear misbalance causing dizziness or blood pressure issues which can cause light-headedness. Also failing eyesight means you may mis-judge uneven surfaces, or distances from objects. All of these situations can easily lead to falls.

How big a problem is this?It is estimated that 30% of the over 65's fall every year, and more than half of the over 75's living in nursing homes or care facilities are unable to live independently because of falling.Women suffer from bone thinning (osteoporosis) and this increases the risk of hip fractures if they suffer a fall. Almost 50% of hip fractures are seen in people who had no mobility problems prior to their fall, however only 50% recovered to their previous level of mobility (NICE 2012)

How does this affect you?

Every time you walk you put all of your weight on your front foot as you lift the back foot up to swing it through. If you step on an uneven surface, ice or simply misjudge the height of a kerb you will need to be able to balance on one leg for that little bit longer than usual to avoid falling. This is particularly true when walking down steps.

When you reach up to a high shelf you probably balance on one leg to gain extra height.

When you get out on the car you will place one foot down and put your weight through that leg as you push up to standing. The added twist provides more challenge to the balance and it is easy to strain your back if your muscle structure doesn't support you too.

Things to remember

Balance can be improved with practise both in a controlled environment such as with an exercise therapist and at home.

Improved core strength gives better balance.

A fall can signal the end of independent living, changing your life completely.

Physical Therapists and Practitioners: which one is right for me?

There are a whole host of people out there offering a service to improve your physical being. Some have virtually no training, others have trained for years. Some provide a diagnosis, others just relieve stress. Some are very different, Pilates vs Indian head massage, while others are confusingly similar, osteopathy vs physiotherapy vs chiropractic. Some provide regular exercise, others are more remedial. So which one is right for you?

To look at it another way, for what should I go to each person? Or, what can I expect from each visit? Unfortunately, and possibly surprisingly there is not a straight forward answer to this (except possibly for GPs). Mainly because each therapy is practiced by an individual and your experience will vary greatly, even within a single discipline, depending on that individual’s experience, capabilities and beliefs. The best thing to do is book a consultation session so the practitioner can explain what services they offer, what you can expect to experience with them and a recommendation as to what would be best for you. Alternatively talk to someone who has been to a session and get a recommendation.

To help you choose which is right for you we can identify some basic information about each therapy.

1 Medically qualified and registered practitioners.

GP – For diagnosis and medical knowledge. Your GP is the first place to go for any diagnosis. If your GP cannot complete a diagnosis he will be able to send you to someone who can. • Physiotherapy – For injury rehabilitation with medical knowledge. A physiotherapist will work generally on a specific site on your body. They may use manipulation techniques and suggest exercise programmes. • Chiropractic – For diagnosis, medical knowledge, injury rehabilitation and chronic pain relief. According to the Collins English Dictionary this is a system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. They use manipulation and movements beyond your normal range. They tend to do this quickly, many people will recognise this as “clicking”. • Osteopathy – For diagnosis, medical knowledge, injury rehabilitation and chronic pain relief. According to the Collins English Dictionary this is a system of healing based on the manipulation of bones or other parts of the body. This is a more holistic approach than chiropractic, but they also use movements beyond your normal range. They tend to do this slowly, manipulating and stretching the muscles and tendons.

Bear in mind that, with the exception of GPs, you might have a very similar treatment from any of the above therapies and differentiation can be quite difficult. They all undertake many years of training in their own discipline and are required to be registered to practice.

2. Exercise Methods:

Yoga – An ancient teaching from India. It is as much a way of life as an exercise class. There are many types. Some will include extreme positions and movements to improve strength and flexibility. Some include meditation, breathing, and relaxation techniques. Some will use flowing movements through a range of positions to achieve strength and flexibility. Try to talk to your yoga teacher prior to attending a class to establish whether the class will suit you. Generally you can expect a Yoga class to be physically challenging and involve a lot of stretches, balances and quiet reflection. • Pilates – Invented in the early 20th century by Joseph Pilates. This concentrates on the development of the “core” musculature. Again there are a number of variations from the pure, following exactly the original moves and approach, to fitness based and hot Pilates. Generally you can expect a Pilates session to be full of small slow movements coupled with balance. The focus is on correct technique to ensure the engagement of the important “core” muscles of the body. • Gym Training – A range of strength and cardio-vascular training equipment can be found in most gyms. Trained staff are on hand to explain the use of the equipment, and you would expect to have a personal programme to follow developed by one of the trainers. The staff are usually fitness experts but may not necessarily have any more specific training or expertise. Generally you can expect to be left to follow your own programme at your own pace in your own way. • Exercise classes – There are a large range of general exercise classes from circuit training to spin, from British Military Fitness (BMF) to Zumba. They are normally quite large classes (8 to 30 and more) and can be very social. There is usually a large cardio element to these classes, some also include strength work. You can expect to work hard, work up a sweat, and gain stamina. • Personal training – Otherwise known as one-to-one or consultancy. This category covers a wide range of services from specific sport training, through weight loss and life coaching, to back care and post-operative exercise. Some personal trainers are also qualified in massage techniques and a one-to-one session can help enormously to get the best out of classes such as yoga and Pilates. You can expect personal and tailored interaction but make sure you understand the qualifications of your trainer and that they match your goals. These one-to-one sessions are usually invaluable in helping people to meet their goals by selecting the best therapies and explaining the important techniques.

Once again it is a good idea to discover what qualifications and experience your trainer has, for any of these exercise therapies. Do remember that an inexperienced therapist can be just right for you, and an experienced, well qualified therapist may not suit your requirements. That situation is rare, it would be more normal for you to get a fuller, more effective and more enjoyable class from a more qualified and experienced instructor. In other words, to some extent, you will need to “suck it and see”. Just because you went to a Pilates class and it made your back hurt, that doesn’t mean that all Pilates classes would make your back hurt.

3. Massage Therapy (soft tissue therapies).

Sports Massage – Despite its name this is not just for fit and active people. It is a deep massaging technique that focuses on areas of tight or knotted muscles and aims to release them by manipulation and the use of pressure. It can be quite painful, and often the massaged areas can be worse for a couple of days. Generally there is noticeable improvement after that. Having said that, very often it is not painful, and the improvement can be immediate. It is unlikely to be a relaxing experience although some people do find it so. Look for a sports massage if you have muscles that are knotted. Deep massage can encourage a healthy circulation before strenuous activity and a sports massage therapist can also provide post exercise or event massage. • Myofascial Release – Your whole body is covered with the fascia. It is under the skin, but over the muscles. If you look at a joint of meat the fascia is the white fibrous covering. In the best circumstances the fascia is taut yet flexible. In most people it has areas where it is attached to muscles, or damaged, or affected by scar tissue and so on. It can be like having a large rubber band holding your body out of alignment. As a result you may have pain in a shoulder that is cause by tight fascia running down your leg. A Myofascial massage is different from any other soft tissue therapy and feels gentle. The aim is to free the fascia to allow the body to align itself correctly. Look for a fascial release massage to ease those aches and pains, or to correct a postural anomaly. • Manual Lymphatic Drainage – Generally known as MLD. The body’s lymph system is just as important as the blood system, although not many people realise just how essential it is. Without lymph your blood would not get oxygen from the lungs, and your muscles would not get the oxygen from the blood. Not only that, but the body’s immune system would not work at all properly. It is lymph that is normally responsible for swelling at injury sites. Lymph is circulated around the body, but it doesn’t have pipes and a pump like blood, it relies on muscle movement and gravity to get around. There are specific sites around the body that process lymph, called lymph nodes. It is here that the lymph is processed to allow it to fulfil its many functions. The movement of lymph around the body can be adversely affected by inactivity, injury, illness and pressure. You should consider MLD if you have swelling, such as post joint replacement surgery, joint pain, or sinusitis. Since the lymph system is in the skin MLD is extremely gentle, but its effects can be immediate and dramatic. • Swedish Massage – Probably the best known massage. There are a wide range of generic massage techniques, such as this, that have general positive effects, but are not targeted like the techniques covered so far. They range from light to deep massages, some involve slapping and or drumming actions, others are done with the feet. Swedish massage will stimulate the circulation and be both enjoyable and very relaxing. • Hot Stone Massage – The use of pre-heated stones helps in many ways to increase the effect of massage. Hot stone massages are extremely relaxing. The heat from the stones encourages circulation and the muscles to relax. Using a hot stone to massage with has the effect of a deep massage without the need for so much pressure. Try one of these if you are stressed, or if you have any particularly stiff or knotted muscles. • Indian Head Massage – Although it is called a head massage you will normally get a head, face, neck and shoulder massage. It is said to stimulate hair growth, but it is definitely a most relaxing massage. It can be done with the client in a sitting position, and fully clothed, so it is ideal for an office environment, or anywhere away from a massage couch. When I have given these types of massage it is quite normal for my client to fall asleep, such is the relaxing effect of the technique. It is very good at reliving the tension in the shoulders that results from sitting at a desk working a computer. Try one of these if you are stressed, have a stiff neck, have a head ache or just fancy a good old pampering.

Which massage may suit you is very difficult to identify, a particular massage for one person can be brilliant, the same massage for another person can be debilitating. Have a conversation with your chosen therapist about your own preferences and any medical conditions you may have. If you have a bad reaction after a massage it is worth letting the therapist know and going back for another try. Most qualified soft tissue therapists will have a range of techniques at their command and will be able to take an alternative approach to avoid any bad reactions.

4 Other specialist areas

Postural Assessment • Therapists with a postural assessment qualification will be able to identify any postural issues that may be causing pain, or imbalance. They will have a thorough knowledge of the musculature that is essential to correct stance. This is applicable to both exercise and massage therapists.Bio-MechanicsThis area is a whole profession in its own right. Usually employed to gain the maximum performance from athletes and sports people, it has an application for everyone. A therapist with bio-mechanics training will be able to help anyone to a better understanding of their body and, generally, to identify an alternative approach to solving issues such as back pain, knee pain and the correction of running or walking style (gait).GP ReferralThis qualification enables exercise therapists to understand and make allowances for chronic conditions presented to GPs which would benefit from exercise. A therapist with this knowledge can support not just GPs, but any of the medical therapists (osteopaths, chiropractors and physiotherapists). Often this support can be in the form of specific exercise plans, but may also be particular massage techniques.Back PainThe causes of back pain are myriad. Sometimes there is a medically identifiable issue (e.g. herniated disc), but often there is no specific reason for the pain. Where this is the case therapists with specific training in dealing with back pain are able to help with targeted exercise plans, manipulations and massage.

In short, look at the qualifications of your chosen therapist and make sure that they meet your requirements.Remember that you can get a good result from a newly qualified therapist, but if you have a recurrent problem to solve, look for qualifications, experience and evidence of on-going training, as research continues to improve the way we treat physical conditions.